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Thursday, October 16, 2014

Radiation and chemo

On Wednesday, Marshall saw the dentist. He worked on the dentures some more and Marshall said they felt pretty good when we left the office but within a few hours -- and after eating lunch -- the pain was back. So we will need to see him again.

This morning he got lab work done and then we saw the oncologist. The PSA is now up to 33. Dr. Flaig brought up the scans taken this week and compared them to the scans taken last month and on the bone scan there is a new area in the mid-back. However, when he looked at the CT scan, that new area didn't show up. He said that CT scans take over a thousand images but they can still miss things.

And there is cancer growing in the left hip area.

Dr. Flaig said that even though the PSA is rising, the progression of the cancer is fairly slow. But he says it is time to move on to new treatments. So we are discontinuing the Zytiga immediately.

And he scheduled us with the radiation oncologist to get radiation on Marshall's left hip. We see him on Monday to get it in place.

Then he said there are three options for going forward:

1. A new drug called Xtandi. Dr. Flaig does not recommend Marshall going on Xtandi because a small percentage of men have had seizures as a side effect and have fallen and fractured a bone, which in his words would be "devastating."

2. Old-fashioned chemotherapy (docetaxel) by infusion. Dr. Flaig does not recommend this either because he thinks Marshall has weakened over the past 2-1/2 years and that this type of chemo would weaken him more and make it more likely that he might fall.

3. Chemotherapy by pill (cytoxin). This is what Dr. Flaig recommended, so we are starting cytoxin tomorrow. He said that compared to the docetaxel, the cytoxin is a VERY low dose and the side effects should be minimal. He also said that the cytoxin works in about 40% of men. Marshall will be monitored every three weeks to check his blood counts and kidney function.

So we went to the pharmacy at the hospital and got the cytoxin prescription filled and we had to pay $181. Good grief.

We talked to the doctor about the excruciating pain Marshall has been having and he said that the way Marshall describes the pain it sounds muscular to him. He recommended taking 2 oxycodone every 6 hours and seeing if the pain lets up over the next few days. I personally think the pain could be related to stress (he's been worried about this visit for 5 weeks). I think it will let up now that we have a plan of action.

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